According to the 2010 National Survey on Drug Use and Health(NSDUH), about 2.4 million Americans use prescription drugsfor non-medical purposes (in other words, without a prescription or to get high). In November 2011, the U.S. Centers for Disease Control reported that the death toll from narcotic pain reliever overdose — about 15,000 a year, or 40 deaths a day — is now greater than that of heroin and cocaine combined.
It’s understandable, then, that critics of these new superdrugs cite the potential for addiction and abuse as a reason for caution.
Dr. Gharibo acknowledges that abuse is a concern with opioid narcotics: “The majority of the misuse out there starts out very casually. Patients may double up on their medications and then build up a certain degree of tolerance.” He also notes: “There’s a lot of misprescribing out there that pretty much started in the late ’90s, where we started overprescribing opioids. Now we’re sort of treading back from what we did. There’s a pendulum that goes back and forth.”
Critics have also noted that Zohydro can be easily crushed, a feature popular with addicts who can snort the powder for an immediate high. OxyContin, which was initially also crushable, now comes in a more tamper-resistant form. Gharibo says, “For those products that are lacking the tamper resistance, it’s sort of like lacking the seat belt on a car. It’s just too easy to abuse.” He notes that more tamper-resistant opioid formulations are expected to become available over the next decade.
According to the AP article, patients taking the new superdrugs will be more closely supervised, since under government regulations a refill of pure hydrocodone requires a new prescription. By comparison, Vicodin may be refilled up to five times within six months of the time the initial prescription was written.
Acetaminophen: Safety Concerns
There’s another advantage to the new drugs: The makers of Zohydro also claim that it will actually be safer than Vicodin, since unlike that medication it won’t contain acetaminophen. Acetaminophen is the main ingredient in the nonprescription painkiller Tylenol, and it’s also found in many over-the-counter cold drugs. But too much acetaminophen can be harmful to the liver, and because it’s in so many products, overdose is a real danger.
“Oral acetaminophen toxicity is the leading cause of liver transplantations in the country,” says Dr. Gharibo, adding that often patients are unaware of their total acetaminophen intake.
Bottom line: These new pain medications ”could be a valuable addition,” says Gharibo. “It could be useful to have a broader palette to utilize, so that we don’t have to keep going up and up on the dosing for the drugs that are available now. I wouldn’t keep this particular compound from being approved.”
But, he says, Zohydro and the other super painkillers should only be used for a limited time and only for those patients who can follow their doctors’ directions and who are psychologically stable, ie, not prone to addiction. “They have to be used for the right clinical indication, in the right patient, and in the right setting.”